About

Marcia C Mecca, MD, is an Associate Professor of Medicine (Geriatrics) at Yale School of Medicine. Her research interests include health priorities, multiple chronic conditions, and polypharmacy, with a focus on improving care for older adults. She has contributed to the development of frameworks and interventions aimed at aligning healthcare with what matters most to patients, particularly those with complex health needs. Her work includes exploring treatment burden, implementing patient priorities care, and advancing age-friendly health systems. Dr. Mecca has been involved in various studies and guidelines that emphasize patient-centered care, communication, and the management of multiple chronic conditions in older populations.

Research topics

• Medicine
• Data Mining
• Computer Science
• Gerontology
• Data science
• Intensive care medicine
• Psychiatry

Selected publications

• Understanding the Role of Communication in Deprescribing Behavior Change

  Journal of the American Geriatrics Society · 2026-04-05

  articleOpen access

  BACKGROUND: The use of behavior change models to conceptualize deprescribing provides an opportunity to explore the components of communication needed to overcome the many barriers to deprescribing. METHODS: Consensus development working group composed of care partner stakeholders and international experts in geriatrics, nursing, pharmacology, communication, and community outreach. The goal of the working group was to create a framework for the communication required among patients, care partners, and clinicians in the ambulatory setting to achieve the behavior of shared decision making about medication appropriateness and deprescribing. The COM-B (Capability, Opportunity, Motivation-Behavior) model provided an apt framework for characterizing deprescribing communication. RESULTS: Each component of the model requires specific communication skills, modes, and/or content. Capability requires clinician skills including elicitation of patient/care partner concerns and patient/care partner skills including self-efficacy for raising medication questions and concerns. This facilitates a shared understanding of constructs that inform communication content, including medication benefits and harms and the "how-to" of deprescribing. Opportunity requires the allocation of time during usual care or the creation of designated visits for communication. Motivation requires communication, such as audit and feedback directed at clinicians, and testimonials directed at patients and care partners, that encourages evaluation of medication appropriateness, increases awareness of potential problems, and overcomes clinical inertia. CONCLUSIONS: The application of a behavioral health model to deprescribing communication highlights the importance of addressing capability, opportunity, and motivation in behavior change. Developing communication strategies that address these three components may enhance the effectiveness of deprescribing interventions.

  PublisherDOI

• Identifying Implementation Needs and Developing Strategies to Optimize Integration of Patient Priorities Care in Primary Care: A Qualitative Formative Evaluation of Two Study Sites

  Journal of General Internal Medicine · 2025-10-13

  articleOpen access
  PublisherOA PDFDOI

• Joint Clinical Practice Guideline on Benzodiazepine Tapering: Considerations When Risks Outweigh Benefits

  Journal of General Internal Medicine · 2025-06-17 · 23 citations

  reviewOpen access

  DESCRIPTION: The American Society of Addiction Medicine (ASAM) has partnered with nine other medical societies and professional associations representing a wide range of clinical settings and patient populations to provide guidance on evidence-based strategies for tapering benzodiazepine (BZD) medication across a variety of settings. METHODS: The guideline was developed following modified GRADE methodology and clinical consensus process. The process included a systematic literature review as well as several targeted supplemental searches. The clinical practice guideline was revised based on external stakeholder review. RECOMMENDATIONS: Key takeaways included the following: Clinicians should engage in ongoing risk-benefit assessment of BZD use/tapering, clinicians should utilize shared decision-making strategies in collaboration with patients, clinicians should not discontinue BZDs abruptly in patients who are likely to be physically dependent and at risk of withdrawal, clinicians should tailor tapering strategies to each patient and adjust tapering based on patient response, and clinicians should offer patients adjunctive psychosocial interventions to support successful tapering.

  PublisherOA PDFDOI

• What Matters Most: An Example of Implementing Patient Priorities Care

  The Senior Care Pharmacist · 2025-07-01 · 1 citations

  article1st authorCorresponding

  This is the first in a series of Age-Friendly case studies developed as a function of the John A. Hartford Foundation grant to the American Society of Consultant Pharmacists and the Peter Lamy Center on Drug Therapy and Aging at the University of Maryland School of Pharmacy to Leverage Pharmacists as Age-Friendly 4Ms Champions. This series presents a case for each of the 4Ms: What Matters, Medication, Mentation, and Mobility, and examines how these elements interrelate to optimize care for older patients. This report involves adopting the 4Ms Framework of an Age-Friendly Heath System (What Matters, Medication, Mentation, and Mobility) in combination with the Patient Priorities Care (PPC) approach for a female patient with multiple chronic conditions. PPC supports patients and care teams in aligning health care decisions with what matters most to the patient. While applicable to all patients, it is particularly valuable for older patients with multiple chronic conditions, such as the patient in this case.The authors sought to identify what matters most to the patient, specifically her desires to spend more time with her grandchildren, volunteer in her community, and maintain independence in mobility. They then worked with the care team to determine how best to support those goals.Fatigue was identified as the greatest barrier. The team evaluated potential interventions to reduce the patient’s fatigue, considering their risks, benefits, relative likelihood of effect, and feasibility. After engaging in collaborative decision-making with the patient, the team selected an intervention and followed up to assess its impact on the patient’s ability to achieve her goals.This case illustrates how the PPC approach can help operationalize patient-centered care by aligning clinical decisions with what matters most to older adults with multiple chronic conditions.

  PublisherDOI

• Guiding Age-Friendly Care Through “What Matters”: Restoring the Whole Person Back into Clinical Practice

  Journal of General Internal Medicine · 2025-07-25 · 1 citations

  editorialOpen access
  PublisherOA PDFDOI

• Age Friendly Health System 4M Competency-Based Curriculum for Internal Medicine Residents

  Innovation in Aging · 2025-12-01

  articleOpen access

  Abstract The Age Friendly Health System 4Ms is an evidence-based framework to provide high value care to older adults, with which educational content in Geriatrics is increasingly aligned. Focusing on Internal Medicine residents, who provide care to older adults in a variety of settings, we aimed to assess perceived proficiency in core competencies, as identified by AGS/ADGAP and organized using the 4Ms framework. We surveyed Internal Medicine residents in three programs at one academic medical center. The survey asked residents about their self-reported proficiency in AGS/ADGAP competencies on a scale of 1-5 (1 “completely unable to perform this skill”, 5 “I am expert and can teach this skill to others”). A total of 35 residents responded to the pre-curriculum survey, including 13 PGY1, 17 PGY2 and 5 PGY3 residents. Most (71%) had no Geriatrics-focused experience in medical school, yet 27 individuals (77%) had >1 Geriatrics rotation during residency. Residents self-reported lower proficiency scores in competencies related to mobility (3.21) and multicomplexity (3.39). Of the competencies, residents scored lowest in their ability to screen for pressure injuries (2.95) and develop a multifaceted plan for fall prevention (3.00). Our findings highlight gaps in Internal Medicine residents’ self-reported proficiency in key Geriatrics competencies. These results will inform our development of a QR-generated skills tracker for residents to have skills in Geriatrics evaluated in real time by trained faculty. This will also help align curricular content in didactics and rotations to target highest priority learning needs.

  PublisherOA PDFDOI

• Understanding Differences in Treatment Burden Among Older Adults with Multiple Chronic Conditions

  Innovation in Aging · 2025-12-01

  articleOpen access

  Abstract Older adults managing multiple chronic conditions (MCCs) often need to balance various medications, treatments, and interventions, so this group of older adults is expected to experience healthcare burden. In this study, we examined the treatment burden of a group of 397 veterans who were older than 65 with three or more chronic conditions and/or ten or more medications. Of this group, 115/397 surprisingly reported no burden (NB) on the Treatment Burden Questionnaire (overall score = zero) while 282/397 reported an average score of 50 during baseline data collection. A chi-square test was run on different demographic variables to determine differences between participants reporting NB versus some burden (SB). NB and SB groups had older adults of similar race, gender, ethnicity, housing status, and educational level. However, older adults reporting NB more frequently reported perfect scores on the PROMIS questionnaire (NB: 48.7%; SB: 17.4%) and a 27/30 (90%) or better on the WBS questionnaire (NB: 52.2%; SB: 19.9%). Older adults reporting SB more frequently reported using assistive devices (NB: 20%; SB: 34.8%) and feeling as if every task was effortful (NB: 23.5%; SB: 40.8). These findings suggest that despite similar background and management of MCCs, older adults with minimal functional and mobility limitations often report NB. Furthermore, perceptions of treatment burden are related to perceptions of wellbeing and quality of life.

  PublisherOA PDFDOI

• Age Friendly Health System 4M Competency-Based Curriculum for Internal Medicine Residents

  Innovation in Aging · 2025-12-01

  articleOpen access

  Abstract The Age Friendly Health System 4Ms is an evidence-based framework to provide high value care to older adults, with which educational content in Geriatrics is increasingly aligned. Focusing on Internal Medicine residents, who provide care to older adults in a variety of settings, we aimed to assess perceived proficiency in core competencies, as identified by AGS/ADGAP and organized using the 4Ms framework. We surveyed Internal Medicine residents in three programs at one academic medical center. The survey asked residents about their self-reported proficiency in AGS/ADGAP competencies on a scale of 1-5 (1 “completely unable to perform this skill”, 5 “I am expert and can teach this skill to others”). A total of 35 residents responded to the pre-curriculum survey, including 13 PGY1, 17 PGY2 and 5 PGY3 residents. Most (71%) had no Geriatrics-focused experience in medical school, yet 27 individuals (77%) had >1 Geriatrics rotation during residency. Residents self-reported lower proficiency scores in competencies related to mobility (3.21) and multicomplexity (3.39). Of the competencies, residents scored lowest in their ability to screen for pressure injuries (2.95) and develop a multifaceted plan for fall prevention (3.00). Our findings highlight gaps in Internal Medicine residents’ self-reported proficiency in key Geriatrics competencies. These results will inform our development of a QR-generated skills tracker for residents to have skills in Geriatrics evaluated in real time by trained faculty. This will also help align curricular content in didactics and rotations to target highest priority learning needs.

  PublisherOA PDFDOI

• Communication as a key component of deprescribing: Conceptual framework and review of the literature

  Journal of the American Geriatrics Society · 2024-12-11 · 12 citations

  reviewOpen access

  BACKGROUND: Deprescribing, the process of identifying and discontinuing potentially harmful or unnecessary medications, is a key component of caring for older persons. Communication is central to deprescribing. This study's objectives were to create a conceptual framework for deprescribing communication and to apply the framework to evaluate current and potential uses of communication in deprescribing. METHODS: The consensus development working group comprises an international set of 14 experts in geriatrics, clinical pharmacology, communication, community outreach, and care partner stakeholders. Critical literature reviews describe (a) components of communication used in deprescribing randomized clinical trials (RCTs) and (b) the content of studies examining deprescribing communication, knowledge, attitudes, and values. RESULTS: The framework demonstrates that communication extends beyond interactions between clinicians and patients. Communication can occur at the health system level, involving methods such as patient-specific feedback materials and academic detailing. Communication can also occur at the community level, involving entities such as pharmaceutical companies, the internet, community groups, and guidelines. Evaluation of the summary of RCTs against the framework demonstrates that intervention studies overwhelmingly focus on communication in individual clinical and health system-based encounters. Evaluation of the summary of observational studies demonstrates that there has been little study of the communication methods and styles themselves. CONCLUSIONS: Potentially untapped opportunities exist to expand the use of different approaches for communication in deprescribing interventions, particularly in the community setting. More studies are required to elucidate and personalize the best content and style of deprescribing communication.

  PublisherOA PDFDOI

• Polypharmacy, deprescribing, and trust in the clinician–patient relationship

  Journal of the American Geriatrics Society · 2024-01-17 · 4 citations

  letterOpen accessSenior authorCorresponding

  The authors have no conflicts.

  PublisherOA PDFDOI

Frequent coauthors

• Terri R. Fried

  Yale University

  30 shared

• Adam P. Mecca

  Yale University

  26 shared

• Corey Hassell

  Medical University of South Carolina

  14 shared

• Lea Kiefer

  Baylor College of Medicine

  14 shared

• Lilian Dindo

  14 shared

• Aanand D. Naik

  14 shared

• Maria Zenoni

  13 shared

• Angela G. Catic

  Baylor College of Medicine

  13 shared